Single versus bilateral lung transplantation in idiopathic pulmonary fibrosis: A systematic review and meta-analysis.

Diandian Li,Bo Wang,Yi Liu,Atsushi Miyamoto

doi:10.1371/journal.pone.0233732

Diandian Li, Bo Wang + Show 2 more

Open Access

https://doi.org/10.1371/journal.pone.0233732

Copy DOI

Abstract

ObjectiveLung transplantation remains the only curative treatment for end-stage lung disease, conferring a better survival for some IPF patients, but whether they should receive double lung transplantation (DLT) or single lung transplantation (SLT) is still controversial. The aim of this study was to determine which type of lung transplantation was more effective and relatively safe in IPF patients by meta-analysis.MethodsPublications comparing overall survival (OS) or other perioperative characteristics between IPF patients undergoing SLT and DLT were selected from electronic databases. The hazard ratios (HRs) were abstracted or calculated to evaluate the survival outcome. Odds ratios (ORs) or mean differences (MDs) were used to compare the causes of death or perioperative parameters. A random-effect model was used to combine data. Heterogeneity was quantified by means of an I2 with 95% confidence interval (95% CI). The publication bias was estimated using the Eggers test with Begg’s funnel plots.Results16 studies with 17,872 IPF cases who met the inclusion criteria were included in this meta-analysis. SLT was associated with declined post-transplant FEV1% (MD = -15.37, 95% CI:-22.28,-8.47; P<0.001), FVC % (MD = -12.52, 95% CI:-19.45,-5.59; P<0.001) and DLCO% (MD = -13.85, 95% CI:-20.42,-7.29; P<0.001), but no significant advantage of DLT over SLT was seen in the overall survival outcome (HR = 1.08, 95% CI: 0.91–1.29; P = 0.391). Subgroup analyses for studies of follow-up period ≥ 60 months also showed similar results (all P-values>0.05). Moreover, there was fewer deaths attributable to primary graft dysfunction in SLT recipients (OR = 0.31, 95% CI: 0.2–0.48; P<0.001), while more patients with SLT died of malignancy (OR = 3.44, 95% CI: 2.06–5.77; P<0.001).ConclusionOur findings suggest that DLT was associated with better postoperative pulmonary function, but there was no difference in long-term overall survival between patients undergoing DLT and SLT. However, further high-quality and large-scale studies are needed to confirm these findings.

Highlights

Idiopathic interstitial pneumonia (IIP), with unknown etiology, has major implications for prognosis and management
single lung transplantation (SLT) was associated with declined post-transplant FEV1% (MD = -15.37, 95% confidence interval (95% CI):22.28,8.47; P
Our findings suggest that DLT was associated with better postoperative pulmonary function, but there was no difference in long-term overall survival between patients undergoing DLT and SLT

Summary

Introduction

Idiopathic interstitial pneumonia (IIP), with unknown etiology, has major implications for prognosis and management. Idiopathic pulmonary fibrosis (IPF), a chronic and progressive interstitial fibrotic lung disease, where no cause can be identified, is one of the most common types of IIP and remains a fatal disease with a median survival time from diagnosis of two to five years. Current treatment options for IPF are limited Antifibrotics, such as pirfenidone and nintedanib, have shown promising results in slowing disease progression [1, 2], it may bring potential serious side effects and help little for end-stage disease. As an increasing number of IPF patients are present for lung transplantation, one question has arised which type of lung transplantation the patients should receive. Numerous studies suggested that the use of SLT versus DLT in IPF did not correspond to significantly different survival [5,6,7]

Methods

Results

Conclusion